Autologous transfusion techniques: a systematic review of their efficacy

Abstract

Shortages of donor blood and fears of transmitted infections have prompted the use of a range of blood-sparing techniques in the peri-operative period. We conducted a systematic review of three techniques that involve the re-infusion of a patient's blood--pre-operative autologous blood deposit (PAD), acute normovolaemic haemodilution (ANH), and cell salvage (CS). We examined the effects of these interventions on the need for peri-operative allogeneic red blood cell transfusion and on clinical outcomes. Controlled clinical studies were identified by computer searches of comprehensive electronic databases and bibliographic searches of published articles. The literature search retrieved a total of 68 randomized trials (RCTs) and 81 controlled observational studies that included data from over 34 000 individuals. In summary, the RCTs found that autologous transfusion techniques consistently reduced the frequency of allogeneic transfusions, with intervention effect sizes ranging from a relative 63% reduction (95% CI 46-74%) with PAD, to 42% (27-53%) with CS and to 31% (16-44%) with ANH. Non-randomized studies reported larger effect sizes than RCTs. PAD increased overall transfusion rates by 30% (95% CI 12-48%) and reduced pre-operative haemoglobin levels by an average of 1.23 g dL(-1). Intervention effects were substantially reduced when these techniques were performed under transfusion protocols. Interpretation of the studies was hampered by serious methodological weaknesses, particularly inadequate randomization techniques, unblinded measurements and the subjective nature of the outcome variables. The studies reported few clinical outcome and adverse event data. Previous claims regarding reduced rates of mortality and infection with autologous transfusions were not confirmed.

Minorities Are Less Likely to Receive Autologous Blood Transfusion for Major Elective Orthopaedic Surgery

“…The use of autologous blood transfusion for elective orthopaedic surgery is decreasing, despite an overall upward trend in transfusion rates driven by an increase in allogeneic transfusions [7,45]. The decrease in this practice may be attributable to growing concerns regarding its cost-effectiveness and utility in patients without anemia [4,6,18,20], the possibility of iatrogenic anemia leading to increased overall transfusion rates [9,12,19], and some reports suggesting no differences regarding postoperative mortality and infection compared with allogeneic transfusions [9,30]. It therefore is possible that patients of higher socioeconomic status are asking for preoperative donation of blood to their own detriment, and, paradoxically, disadvantaged populations may not be receiving substandard care.…”

Strategies for reducing the exposure to donor blood

“…14,15 Much of the evidence suggesting a benefit from autologous transfusion is derived from methodologically poor studies with inadequate clinical outcomes. 15 Pre-operative Sufficient time should be allocated for the identification and treatment of anaemia, ideally in the setting of a surgical pre-assessment clinic. 14 Drugs that interfere with haemostasis should be discontinued wherever possible.…”

Efficiency and Cost Analysis of Cell Saver Auto Transfusion System in Total Knee Arthroplasty

“…This was associated with an increased IL-6 level in the blood drained in the early postoperative period. Carless et al (20) argued that autotransfusion should be applied carefully due to problems such as air emboli, infection, nephrotoxicity, metabolic hyperchloremic acidosis and disseminated intravascular coagulation. In the current study, two CSS patients reported shivering following re-transfusion and this was solved by ending re-transfusion.…”